Internal medicine journal
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Internal medicine journal · Nov 2024
Diagnosis and management of mantle cell lymphoma: a consensus practice statement from the Australasian Lymphoma Alliance.
Mantle cell lymphoma (MCL) is a clinically heterogeneous B-cell neoplasm with unique clinicopathological features, accounting for 5% of all non-Hodgkin lymphoma. Although for many chemoimmunotherapy can lead to durable remissions, those with poor baseline prognostic factors, namely blastoid morphology, TP53 aberrancy and Ki67 >30%, will have less durable responses to conventional therapies. With this in mind, clinical trials have focused on novel targeted therapies to improve outcomes. This review details the recent advances in the understanding of MCL biology and outlines the recommended diagnostic strategies and evidence-based approaches to treatment.
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Internal medicine journal · Nov 2024
The importance of assessing and correcting hydration status prior to right heart catheterisation: a pilot study.
We evaluated whether fluid status could be accurately assessed (and corrected if necessary) prior to right heart catheterisation (RHC), to diagnose accurately post-capillary pulmonary hypertension (PHT) in patients with left heart disease risk factors. A non-invasive measure of fluid status prior to RHC identified fluid-depleted patients. Baseline RHC measurements were performed, and a novel provocation technique (passive leg raise) was compared to a 'one-dose-fits-all' fluid challenge and found to be equivalent.
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Internal medicine journal · Nov 2024
Final results of the National Oncology Mentorship Program 2023 and its impact on burnout and professional fulfilment.
Significant burnout and low professional fulfilment are noted among medical oncologists and trainees. The National Oncology Mentorship Programme (NOMP23) was designed to evaluate the impact of a 1-year mentorship program between oncology trainees (mentees) and consultants (mentors) on improving professional fulfilment and burnout. ⋯ NOMP23 demonstrated that a centrally coordinated, low-cost mentorship program could be feasible and was of high value. Mentorship programs, alongside multifactorial institutional, state-based and national interventions to improve well-being, can help ensure a sustainable workforce.
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Internal medicine journal · Nov 2024
Real-world impact of pembrolizumab availability for deficient mismatch repair metastatic colorectal cancer.
Immunotherapy has emerged as a standard treatment for deficient mismatch repair (dMMR) metastatic colorectal cancer (mCRC). Pembrolizumab became widely available as a first-line (1L) option in Australia following the Pharmaceutical Benefits Scheme (PBS) listing in August 2021. The uptake of new treatment options can be lengthy. ⋯ Previously reported associations of dMMR were observed. The higher-than-expected proportion of patients with dMMR is likely driven by the inclusion of older patients in this real-world study. Many patients were able to access immunotherapy prior to PBS listing, potentially through trials or access programs. Early uptake of pembrolizumab following PBS listing has been high, and this effective and well-tolerated option has increased the proportion of elderly patients receiving active therapy.